Organization
RUSSELL & GENC HEALTH AND WELLNESS CENTER CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
IMELDA T RUSSELL CRNP (PARTNER)
(703) 244-4633
Entity
Organization
Contact information
Practice address
6510 KENILWORTH AVE STE 2500, RIVERDALE, MD 20737-1346
(410) 997-1907
Mailing address
6510 KENILWORTH AVE STE 2500, RIVERDALE, MD 20737-1346
(410) 997-1907
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
—
—
363LA2200X
Adult Health Nurse Practitioner
—
—
363LF0000X
Family Nurse Practitioner
—
—
Other
Enumeration date
09/12/2018
Last updated
10/01/2018
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